UNDER THE GUIDANCE OF

DEEPA RAGHUNATH & Dr. GEETA SHIVRAM Dr.

GROUP -18
1) 2) 3) 4) 5)

SANDESH YADAV SANYAM GUPTA SAPNA GAJBHIYE SARIKA ARGADE SOURABH N. JAIN

HEALTH CARE DELIVERY SYSTEM INDIA

IN

Two major themes in the delivery of health services are It should be organized to meet needs of entire population & 1.not merely selected groups . It should cover the full range of preventive , curative & 2.rehabilitation services.

In the beginning ,

LARGE HOSPITALS
Were chosen for health care delivery

LARGE HOSPITALS FAILED

It served only small part of population. Services rendered were mostly CURATIVE only. Cost of maintenance were high. Failure to meet the total health needs of community. This led to development of NEW MODEL OF HEALTH CARE SYSTEM.

MODEL OF HEALTH CARE SYSTEM

INPUT

HEALTH CARE SERVICES

HEALTH CARE SYSTEM

OUTPUT

Health Curative status/Health Preventive problems + promotive Resources

Public Private Voluntary Indigenous

Changes in health status

INPUT
A. Inputs are the health status & major problems of the community. These represents health needs & health demands of community. Data required for analyzing the health situations & for defining the health problems comprises the following Mortality & morbidity status Demographic conditions Environmental conditions Socioeconomic factors Cultural background, attitudes, etc. Medical & health services available.

B.RESOURCES No country, however rich has enough resources to meet the needs for all health care. Basic resources for providing health care are -Health manpower -Money & material -Time

HEALTH MANPOWER
Suggested norms for health personnel
Category of personnel 1.Doctors 2. Nurses 3. Health workers M/F Norms suggested 1 / 3500 population 1 /5000 population 1 /5000 population- plain areas,3000 population-tribal & hilly areas 1/village 1/30000 population-plains,& 1/20000-tribal& hilly areas 1/ 10000 1/ 10000

4. Trained dais 5.Health assistant M/F 6. Pharmacists 7. Lab. technicians

HEALTH CARE SERVICES

Health care services are designed to meet the health needs of the community through the use of available knowledge & resources In the light of health for all by 2000AD the goals to be achieved are fixed in terms of : Mortality& Morbidity reduction Increase in expectation of life Decrease in population growth rate Increase in nutritional status Provision of basic sanitation Health manpower requirement Resource development

HEALTH CARE SYSTEM IN INDIA

DEFINITION-Health care delivery system is one which is intended to deliver the health services ,it constitutes the management sector & involves organizational matters. India is a union of 28 states & 7 union territories. Each state has developed its own system of health care delivery with central responsibility of-

 Policy making Planning Guiding Assisting Evaluating & Coordinating the work, Health Ministry.

of State

THE HEALTH CARE IN INDIA HAS THREE MAIN LINKS

CENTRAL LEVEL STATE LEVEL DISTRICT LEVEL

CENTRAL LEVEL
Consist of I. Union Ministry of Health & Family Welfare II.The Directorate General of Health Services III.Central Council of Health & Family Welfare

UNION MINISTRY OF HEALTH AND FAMILY WELFARE

ORGANIZATION
HEADS

A Cabinet minister

A State minister

A Deputy health minister

Departments U M H F W
1.DEPARTMENT OF HEALTH:Executive Head:- Secretary to the Govt. of India Assisted by
Joint secretaries Deputy secretaries Administrative staff

2.DEPARTMENT OF FAMILY WELFARE:Over all In charge:- Secretary to Govt. of India in Ministry of Health & Family Welfare.

FUNCTIONS
1.Union list: International health relations & administration of port quarantine. Administration of central institutes . Promotion of research through research centers . Regulation and development of medical , pharmaceutical , dental , nursing profession.

Establishment and maintenance of drug standard data. Census & collection of other statistical data. 2.CONCURRENT LIST:Prevention of extension of communicable diseases from one unit to other. Prevention of adulteration of food stuffs. Control of drugs and poisons. Vital statistics. Labour welfare. Population control & family planning.

DIRECTORATE GENERAL OF HEALTH SERVISES

ORGANIZATION Principal advisor-Directorate General of Health Services. Assisted by

Additional Director General Team of deputies Administrative staff

DGHS COMPRISES OF 3 MAIN UNITS

UNITS

Medical care & hospitals

Public health

General administration

FUNCTIONS
International health relations & quarantine at all the major ports. Control of drug standards. Medical store depots to insure quality ,cheaper bargain,& prompt supply. Post graduate training . Medical education- In charge of medical colleges. Planning ,guiding ,coordinating national health programmes.

CENTRAL COUNCIL OF HEALTH

Set up by presidential order on 9th August 1952, under article 263 of constitution of India. AIM:Promoting coordinated and concerted action between centre and state To Implement all programmes and measures pertaining to the health of nation.

Organization

Chair person Union Health Minister Other members State Health Ministers

AT STATE LEVEL
In all the 28 states the management sector comprises of

a.State Ministry of health b.State health Directorate

STATE MINISTRY OF HEALTH

Organization :HEAD

Minister of Health & Family Welfare

A deputy Minister of Health & Family Welfare

STATE HEALTH DIRECTORATE

Organization:Chief advisor:- Director of health & family welfare. Assisted by:- Deputies -Assistants Regional Functional
Inspect all branches of public health within their jurisdiction Specialists

District

TAC
URBAN

RURAL

MB
VILLAGE PANCHAY ATS

SUBDI VISON

TEHSIL

CDB

COORPORATIN

TEHSIL:Between 200-600 villages In charge- Tehsildar. COMMUNITY BLOCK DEVELOMENT Comprises of approx 100 villages. Between 80000-120000 population. In charge-Block development officer.

District oUrban areas rganized into following institutions TOWN AREA COMMITEES
In areas with population of 5000-15000. It is like panchayat. Provide sanitary services.

THE DISTRICT

The principal unit Administration in India .

HEAD:- COLLECTOR There are 539 districts in India. Administrative types under district Sub division:May be 2 or more. In charge- Assistant collector.

MUNICIPAL BOARDS In population of 10000-20000. In charge-President. Functions-Construction & maintenance of roads. -Sanitation, Drainage, Water supply. -Maintenance of hospitals & dispensaries. -Registrations of vitals. COORPORATIO Head-Mayors, Counsilors. Executive agency- Commissioner -Secretary -Engineer

Organization at district level

There should be an integrated set up by having : Chief medical officer 3 Deputy CMOs Each deputy CMO in charge of 1/3rd of the district for all the health, family welfare & MCH services. This set up should be recognized on the basis of the number of Primary health centers it comprises.

PANCHAYATI RAJ
LINK BETWEEN VILLAGE & DISTRICT

AT VILLAGE LEVEL

AT BLOCK LEVEL

AT DISTRICT LEVEL

PANCHAYAT

PANCHAYAT SAMITI

ZILLA PARISHAD

AT VILLAGE LEVEL
Panchayati raj at this level consist of

NYAYA PANCHAYAT

GRAM PANCHAYAT

NYAYA PALIKA

Gram Sabha

Assembly of all the adults.

Meet twice a year. Functions:-Considers proposals for taxations,. -Discusses the annual progarmme. - Elect members of gram panchayat.

Gram Sabha

Assembly of all the adults.

Meet twice a year. Functions:-Considers proposals for taxations,. -Discusses the annual progarmme. - Elect members of gram panchayat.

Gram panchayat

Varies from 15-20 in number. Population covered-5000-15000. Members hold office for 3-4 years. President-SARPANCH Other members-Vice secretary -Panchayat secretary Functions Covers entire field of civic administration.

At the Block level

PANCHAYAT SAMITI/ JANPAD PANCHAYAT Consist of:- Sarpanchas -MLAs , MPs , residing in the block area. - Representatives of women ,SC,ST, cooperative societies. -Ex-officio secretary-Block development officer. FUNCTION:- Execution of the community development program me in the block.

AT DISTRICT LEVEL
ZILLA PANCHAYAT Organization:-Head of the panchayat samitis -MLAs , MPs , residing in the block area. -Representatives of women ,SC,ST, cooperative societies. -Two persons of experience in administration or rural development. FUNCTION:- Its a Supervisory & coordinating body.

THE INDIGENOUS SYSTEM OF MEDICINE

Includes AYURVEDA & SIDDHA UNANI & TIBBI HOMEOPATHY UNREGISTERED PRACTITIONERS

These provide a bulk of medical care to rural population.

Ayurvedic physicians alone are estimated to be about 4.38 lakhs. 90% serve rural areas. Local residents ,close to people socially & culturally. ISM drugs are manufactured by Tamil Nadu Medicine Plant Co orporation.

Total values of IMS drugs are Rs 30 crs/Training of the health functionaries on the use of IMS drugs is under progress. Training cost-Rs 3.30 crs/-. Beneficiaries are- 8.6 lakhs and steadily increasing.

HEALTH CARE SYSTEM

1.

FIVE MAJOR SECTORS Public Health Sector a) Primary Health Care - Primary health centers - Sub-centers b) Hospitals / health centre - Community health centre - Rural hospitals - District hospitals/health centers - Specialist hospitals - Teaching hospitals c) Health Insurance Schemes - Employees State Insurance - Central Govt. Health Scheme d) Other Agencies - Defence services - Railways

2.

PRIVATE SECTOR a) Private hospitals, Polyclinics, Nursing homes & dispensaries b) General practitioners & clinics
INDIGENOUS SYSTEM OF MEDICINE a) Ayurveda & Siddha b) Unani & Tibbi c) Homeopathy d) Unregistered practitioners VOLUNTARY HEALTH AGENCIES NATIONAL HEALTH PROGRAMMES

3.

4. 5.

PRIMARY HEALTH CARE IN INDIA

In 1977, the Govt. of India launched a Rural Health
Scheme based on the principle : Placing peoples health in people hands

Based on recommendation of Shrivastav Committee in 1975. As a signatory to Alma-Ata Declaration Govt. of India is committed to achieve the goal of health for all through primary health care approach .

It is a three tier system operating at

VILLAGE LEVEL

SUBCENTRE LEVEL

PRIMARY HEALTH CENTRE LEVEL

VILLAGE LEVEL
To penetrate the health care into the farthest reach of rural area schemes in operation

Village health Guide scheme Training of local Dais ICDS scheme

VILLAGE HEALTH GUIDE/ ASHA

The scheme was introduced on 2nd Oct. 1977 VHG A person with an aptitude for social service & is not a full time govt. functionary. Guideline for selection- Permanent resident of local community - Able to read & write mini. education-VI std Duties : - treat simple ailments - MCH care with family planning - Education- health, sanitation

LOCAL DAIS
All dais are trained to improve their knowledge about MCH & sterilization. Training -PHC centre, sub centre, MCH centre. - 2 days /week for 30 working days. - Conduct at Least 2 deliveries under guidance of HW/ANM. Provided with a delivery kit & a certificate. Also, vital role in propagating small family norm.

ANGANWADI WORKER
Under ICDS scheme 1AWW/1000 population. SERVICES RENDERED Health check up Immunization Supplementary nutrition Health education Non-formal preschool education. BENEFICIARIES- Nursing mother - Women (15-45 years) - Children <6 years

SUB CENTRE LEVEL

A peripheral out post of existing health delivery system in rural area Norms 1 sub centre covers In general 5000 population In hilly tribal area 3000 population Manpower

Supervisors -

1 male MPW 1 female MPW M+F Health assistant for 6 female HW

FUNCTIONS OF SUBCENTRE
MCH Care Family planning services

Immunization
The proposed extension of facilities IUD insertion Simple lab investigations.

PRIMARY HEALTH CENTRE LEVEL

Bhore committee in 1946 gave the concept. According to it, PHC is a basic health unit to provide heath care to the rural population which is As close as possible to people Integrated curative, preventive, promotive. The central council of health in 1953 recommended the establishment of PHC in community development block. The Declaration of Alma-Ata conference in 1978 setting the goal of health for all by 2000 AD has ushered in the primary health care approach. The National Health Plan reorganized PHC on the basis of 1 PHC for

30,000 rural population plains 20,000 population in tribal, hilly, backward areas.

FUNCTIONS OF PHC
It covers all the 8 essential elements of primary health care as outlined in the Alma-Ata Declaration 1. Medical care 2. MCH including family planning 3. Safe water supply & basic sanitation 4. Prevention & control of locally endemic diseases 5. Collection & reporting of vital statistics 6. Education about health 7. National health programmes 8. REFERRAL SERVICES 9. Training of health guides health workers local dais & health assistants 10. Basic lab services Proposed facilities Vasectomy, tubectomy, MTP

STAFF
At the PHC level : Medical officer Pharmacist Nurse mid wife Health worker (female)/ANM Block extension educator Health assistant male Health assistant female U.D.C L.D.C. Lab technician Driver Class IV 1 1 1 1 1 1 1 1 1 1 1 4

HOSPITALS

HOSPITALS

CHC

RURAL HOSPITALS

DICTRICT HOSPITALS

SPECIALIST HOSPITALS

TEACHING HOSPITALS

COMMUNITY HEALTH CENTRE

Established on 31st March 2003 by upgrading the primary health centre. 1 CHC in each community development block covers population 80,000 1.2 lac . It should have : -30 beds -Specialists in surgery, medicine, obstetrics & gynecology pediatrics with X- ray facilities. A new non- medical post : community health officer has been created at CHC to strengthen preventive & promotive aspect of health.

Indian Public Health Standards for CHC

Prescribed to
o o o Provide quality care & optimal expert care Achieve & maintain an standard of quality of care. Monitor & improve functions of CHC

Assured Services
Care of routine & emergency cases in surgery & medicine 24-hour delivery services, including normal & assisted delivery Essential & emergency obstetric care including caesarean section Full range of family planning services Safe abortion services Newborn care Routine & emergency care of sick children

ASSURED SERVICES

cont

Delivery of all national health programmes like : RNTCP NVBDCP HIV/AIDS Control programme Blindness Control programme NLEP IDSP Others : - Blood storage facility Lab services Referral services

ROGI KALYAN SAMITI

CONCEPT
PATIENT WELFARE COMMITTEES AIM To create a model of management of public institutions for the people with active participation of the community and with minimal recourse to the state exchequer.

Constituted by including peoples representatives with a few govt. officials. Given control over all assets of hospital .

OBJECTIVE
Ensure compliance to minimum standard for facility & hospital care. To ensure discipline & monitor accountability . Upgrade & modernize health services. Introduce transparency in management of funds. Supervise implementation of National Health Programmes Organize out reach services.

OBJECTIVE
Generate resources users fees. locally

(cont)
through donation, for

To establish public private betterment of the institution.

partnership

Maintenance & expansion of hospital building. Ensure safe & adequate disposal of hospital waste. Organize training & workshop for staff members.

FUNCTIONS
Identify problem faced by people & solve. Ensure equity via provision of free treatment BPL Ensure proper maintenance of hospital wards beds, equipments. Arrange for good quality diet & stay arrangement for patients attendants. Offer private organs to set up CT Scan, MRI, pathology lab services within hospital premises

USER CHARGES
To ensure excellent health care on cont. basis. Free health care not perceived as best kind of health care. Guidelines are drawn up for user fees e.g. OPD ticket, pathology test, indoor beds, specialized treatment, operations etc. BPL, FF etc.- exempted from user charges. Funds received Deposited in RKS & not in govt. exchequer .

Committees
DISTRICT HOSPITAL (EXECUTIVE BODY): CHAIRMAN: COLLECTOR

MEMBER SECRETARY: Civil Surgeon cum

Hospital Superintendent. MEMBERS :Municipal Commissioner, CEO Zila Panchayat, Chief Medical officer, Senior MO of Hospital, Ex. Eng. PWD, One Donors ( donated Rs.50,000)Nominated by Chairman

Committees
TEHSIL & BLOCK LEVEL HOSPITAL (GENERAL BODY)

CHAIRMAN: MLA of the area. MEMBER SECRETARY: Block MO/ MO of hospital

MEMBERS-

Peoples representatives with few Govt. officials

S.D.M, President Janpad Panchayat, President of Municipality, President of Health Committee of Municipality, CEO Janpad Panchayat, one Parshad of area, SDO. PWD & PHED, Two Donors ( donated Rs. 20,000) nominated by Chairman, Sr. M.O. nominated by CMHO.

Committees
TEHSIL & BLOCK LEVEL HOSPITAL (EXECUTIVE BODY)

CHAIRMAN:

SDM

MEMBER SECRETARY: Block MO/ MO of hospital

MEMBERS : President Janpad, CEO Janpad Panchayat, PWD,
Sr. M.O. nominated by C M H O

Committees
OTHER HEALTH INSTITUTIONS/ DISPENSARY/ PHC (GENERAL BODY):

CHAIRMAN: Janpad Panchayat

Member of area.

MEMBER SECRETARY: I/C MO

Hospital

Committees
OTHER HEALTH INSTITUTIONS/ DISPENSARY/ PHC (EXECUTIVE BODY):

CHAIRMAN: TEHSILDAR/ NAYAB TEHSILDAR.

MEMBER SECRETARY: I/C MO Hospital.

MEMBERS: President of Health Committee of
Nagar/Gram Panchayat, Eng.. PWD & MPEB.

MONITORING COMITTEE

Constituted by Governing body. Visit hospital wards. Collect patients feedback. Send monthly monitoring report to Collector.